Healthcare Provider Details

I. General information

NPI: 1154393353
Provider Name (Legal Business Name): ISLANDS EMERGENCY MEDICAL SERVICE HAWAII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 NORTH KUAKINI STREET
HONOLULU HI
96817-2306
US

IV. Provider business mailing address

5565 CENTERVIEW DR STE 107
RALEIGH NC
27606-3563
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-9593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY KONDAS
Title or Position: OFFICER
Credential:
Phone: 973-251-1132